Chronic Hand Eczema Check-In: Latest Treatments for Troubled Hands

Alexandra Golant, MD and E. James Song, MD reviewed chronic hand eczema (CHE) as a heterogeneous and often refractory condition, defined by disease lasting longer than three months or recurring multiple times within a year. They emphasized that CHE is frequently multifactorial, with nearly half of patients exhibiting overlapping subtypes such as atopic and irritant contact dermatitis. Despite varied clinical presentations, inflammation across CHE subtypes is largely driven by cytokines signaling through the JAK-STAT pathway, helping explain the chronicity and treatment resistance seen in many patients.

Accurate diagnosis remains essential and includes distinguishing etiologic subtypes from clinical morphologies, along with routine consideration of patch testing to identify relevant allergens. However, the presenters noted that allergen avoidance alone often provides incomplete relief, underscoring the need for more effective therapies. A major advance discussed was the approval of delgocitinib 2% cream in 2025, a topical pan-JAK inhibitor for adults with moderate-to-severe CHE inadequately controlled with topical corticosteroids. Data from the DELTA trials demonstrated significant improvements in skin clearance, itch, and pain across multiple CHE subtypes, including hyperkeratotic disease, with minimal systemic absorption and a favorable safety profile.

Additional emerging options were also reviewed, including topical ruxolitinib for rapid itch reduction, biologics such as dupilumab and tralokinumab for atopic-driven disease, and investigational oral agents like abrocitinib and roflumilast. The session concluded with practical management pearls, emphasizing the limitations of long-term topical corticosteroid use and the importance of individualized, subtype-driven treatment strategies to achieve durable control and improved hand function.